When was the last time you worried about something? Really worried.
Think about it. Can you recall what it was?
Did you resolve it? or Are you are still worrying about it? Is this a longstanding issue or a fleeting worry? Can you stop worrying?
Is worry healthy?
Most people worry. You can worry about almost anything. Some say their pets worry about them. Do your pets worry? or Is this only a human projection onto an animal object (see my blog entry on Transference and the Unconscious).
A worry can be big (Do I have Cancer?) or small (Did I lock the door?).
Worry has value. This is a strong affirmative statement, but most people would agree that worry “sometimes” has value. If there is something looming (a thunderstorm), to worry an object is outside could mobilize you to put it in.
Worry can be a reason for therapy. Why? Because worry, especially worrying that won’t stop, is emotionally painful. Doctor, I can’t stop worrying about my health. I can’t sleep because I’m worrying. My doctor tells me I’m healthy. But, still, I worry.
I worry:
About a heart attack.
I might die.
I have cancer.
I will need to go to the hospital.
I will be an invalid.
Something is wrong with me.
To be sure, some people have more reason to worry than others. If you smoke 3 to 5 packs of cigarettes a day, are sedentary, drink alcohol heavily, have a stressful job, have high cholesterol, sleep poorly, snore at night…you have more reason to worry about a heart attack than a health conscious individual. The real question is, Why does the health conscious individual worry more about a heart attack than the poor health behavior person? There are several answers for this, but most likely it is because the health conscious person values her or his health (health is important to this person and that’s why the person exercises). The poor health behavior person values pleasure (through indulgence) or perhaps values a sense of independence or autonomy that she or he can indulge in these behaviors at anytime she or he desires. Worry is about what you value.
In this entry I deconstruct worry, describe what worry is and what it isn’t. I identify when worry is normal versus when it is not. When and How does worry get out of control. If worrying is out of your control, How do you treat it?
Worry Defined?
The dictionary defines worry as: 1: (Noun) : mental distress or agitation resulting from concern usually for something impending or anticipated. Worry can be a (verb). We didn’t want you to worry. Or Don’t worry. You’ll be fine. We think of worry as an action, something we do.
This definition is straight-forward, maybe too simplistic. The actual phenomenon of worry is more complex.
Worry is a mental activity that is an element - or a symptom - of anxiety. Worrying incessantly is a feature of an anxious mind, but worry itself is not a psychiatric disorder.
Similar to anxiety, worry is anticipatory. You worry in the present, usually about the future. You can worry about future implications of something that occurred in the past (or that is happening in the present). Either way, worry is about the future. As I stated earlier, worry is not, in and of itself, a pathological condition or a psychiatric disorder. Rather, it is a specialized kind of thinking that, at its best, helps you anticipate a negative future so that you can act to either prevent something or address a problem in the future. When people worry, it is about something. Absent something specific, you might call the act of worrying a symptom of Anxiety.
Anxiety is an over-arching pathological state (or psychiatric disorder). Anxiety includes as one of its symptoms, worry. In this regard, worrying (as a symptom of anxiety) consists of a chain of negative affectively-loaded thoughts and images that are associated with a personal threat. Worrying can at times become uncontrollable. In this regard, worry is a kind of rumination.
What is rumination?
Rumination is: (1) The act of thinking carefully and for a long period of time about something. (2) Obsessive thinking about an idea, situation, or choice especially when the thinking, itself, interferes with normal mental functioning. What is “obsessive?” “Thinking about something or someone too much in a compulsive manner.”
What it “compulsive?”
…an irresistible urge, especially one that is against one's conscious wishes. When people feel compulsive they feel the urge (an unease) to think about (or act on) something (repeatedly) — until the feeling or urge of unease goes away.
A Psychiatric Definition of “Rumination is”: A form of perseverative cognition that focuses on negative content, generally about a past or present event, and the thinking results in emotional distress. What does it mean to perseverative? To “Perseverate” is: “To repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased.”
Rumination is distinct from worry. Rumination is a kind of perseveration. An easy way to differentiate the two is that: Worry is obsessive (and sometimes perseverative) thinking on the future whereas rumination is always perseverative thinking about the past and/or present.
Mary Worries About A Driving Test
Mary needs to renew her driver’s license. To do so requires that she go to the Department of Motor Vehicles, in person, and take a written test about the rules and laws of driving. She obtains written study materials for the test, but then starts to worry about what would happen if she fails this written test. She was an excellent student in school, including College. She has taken tests, but not for a long time. Still, for some reason, she gets it in her head that she will fail this test. She talks with her friend, Sarah. Sarah tells her, “Mary, even if you fail the test, which I don’t think you will, it won’t be the end of the world. You can just take it again.” Mary understands Sarah intellectually. Sarah is urging Mary not to personalize the test or its outcome. Still, Mary doesn’t think she can manage the feelings of humiliation should she fail this test.
Mary studies and she studies. She finds practice exams on the internet and she takes these and seems to pass them OK. But, still, she keeps worrying about this test and how she will feel if she fails. She doesn’t give a thought to how good she would feel if she passes the test. Why? Because Mary is in a twilight zone of negative bias. In this zone, positive thoughts, affirmations of self, a sense of personal efficacy that you can accomplish this task doesn’t exist. Focus is on the negative, the repercussions of failure. This is what I call “the “Twilight Zone of Negative Bias.”
What is Mary doing while worrying?
Is Mary? 1. Perseverating, 2. Ruminating, 3. Obsessing, 4. Two out of three, 5. All three
Mary starts having trouble sleeping at night, tossing and turning as she imagines herself sitting down at the DMV, taking the test, then failing, then being told by a DMV employee that she will not be able to drive until she can pass the test.
This thought cycles over and over in her mind. The time for the driving test approaches and Mary’s worrying gets worse. She can’t stop thinking about it. Her negative thoughts intensify: day in and day out. Mary is now living with this issue. She isn’t sure she can go through with the test, so she calls the DMV and delays taking the test for another month. She immediately feels better.
What can be done for Mary?
Mary is facing a demand (to drive an automobile). Driving an automobile is not absolutely essential for living, but it is her way of life. Mary probably believes this demand is critical to her wellbeing. But, this is not the core issue.
There is a requirement that Mary take and pass a written test to obtain her driver’s license. This is so that she can continue to drive. But, Mary now believes that taking and passing this test is somehow tied into her self-image. If she takes the test and does not pass she said she will feel “humiliated.” To be humiliated means to feel ashamed and/or foolish by injuring dignity and self-respect. In Mary’s mind, her self-respect hinges on taking and passing the test.
Mary has increased the stakes of the task by linking it to her self-respect. The fact is, taking the test and not passing only means she would need to take it again. Sarah as much as told her this. But, Mary has somehow inserted her self-respect into the equation. For her to anticipate humiliation if she fails suggests that she has inflated her “expectations of failure” around this test. Mary views the test as an existential “threat.”
These are excellent conditions for human worry (mobilizing for a future threat). What Mary does next is predicable. She worries and as she does the looming nature of the test grows larger in her mind, she studies, worries more, in other words, she is mobilizing her resources to address the threat. For Mary, the cost of failure is now so high that it starts to preclude her from staying motivated. She begins to fear and look for an escape route. When you are afraid you want to escape. Delaying the test is one way to escape. Postponing the threat delays the potential for failure. It is a kind of temporary escape, but its cost is increasing Mary’s fear. Her worry has transformed into anxiety. If this keeps going, her anxiety will transform into depression and then, even if she takes the test she might still remain depressed.
Mary has a psychiatric diagnosis. “Test Anxiety.” What is “Test Anxiety”
The Diagnostic and Statistical Manual of Mental Disorders V defines test anxiety as:
An excessive degree of fear, worry, and apprehension before, during, and/or after test situations, with symptoms of physiological reactivity and concern regarding (the consequences of) poor performance.
Although worry, in and of itself, is not pathological, Test Anxiety is.
…test anxious individuals perform worse and, as far as academic performance is concerned, they often remain below their actual potential…This suggests that, without intervention, Mary will probably be so anxious, she will not pass the test, then she will feel humiliated and the cycle will continue.
In addition to experiencing anxiety around her driving test, Mary has negatively impacted her future performance due to her anxious affect. To treat Mary’s condition would require understanding and addressing her test anxious condition.
This example describes how worry can get out of control.
Not all worries end up following this type of pattern. Psychologist have developed instruments to measure both the quantitative and qualitative aspects of personal worry.
Measuring Worry
Below is the Penn State Worry Questionnaire (PSWQ). This is a 16-item instrument that measures worry tendencies and whether these are normal or pathological. See where you score on this scale.
PENN STATE WORRY QUESTIONNAIRE (PSWQ)
Instructions: Circle the response that best describes how typical or characteristic each item is of you (LIKE YOU OR NOT LIKE YOU).
5=VERY MUCH LIKE ME, 4=SOMEWHAT LIKE ME, 3=LIKE ME, 2=NOT LIKE ME, 1=VERY MUCH NOT LIKE ME.
If I don’t have enough time to do everything, I don’t worry about it.
5 4 3 2 1
My worries overwhelm me.
1 2 3 4 5
I do not tend to worry about things.
5 4 3 2 1
Many situations make me worry.
1 2 3 4 5
I know I shouldn’t worry about things, but I just cannot help it.
1 2 3 4 5
When I am under pressure I worry a lot.
1 2 3 4 5
I am always worrying about something.
1 2 3 4 5
I find it easy to dismiss worrisome thoughts.
5 4 3 2 1
As soon as I finish one task, I start to worry about everything else I have to do.
1 2 3 4 5
I never worry about anything.
5 4 3 2 1
When there is nothing more I can do about a concern, I don’t worry about it anymore.
5 4 3 2 1
I’ve been a worrier all my life.
1 2 3 4 5
I notice that I have been worrying about things.
1 2 3 4 5
Once I start worrying, I can’t stop.
1 2 3 4 5
I worry all the time.
1 2 3 4 5
I worry about projects until they are done.
1 2 3 4 5
Scoring: Add up the numbers.
Scores range from 16 to 80 with higher scores indicative of higher levels of trait worry. Scores can be in the following severity ranges.
29 or less: Not anxious or a worrier
30-52: Bothered by worries but below clinical range for worry
52-65: Currently have some problems with worry and may benefit from treatment
66 or more: Severe worrier and in need of treatment to target this problem
If you scored 66 or more you would be scoring similar to those who are categorized as severe worriers. Below is a description of a Severe Worrier.
Severe worriers (scores 52 and above) tend to be more self-evaluative, socially anxious and perfectionistic. They feel time-pressured, and report frequent obsessional symptoms. They experience a greater tendency to negative daydream and report less attentional control than non-worriers (scores less than 52). Worrying requires attentional resources and results in poorer problem solving efforts and interrupted task completion.
THIS BLOG IS CONTINUING, JULY 25, 2022